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�frVKV�Is��:----- 5 � N ----------- ---- --- --------------- --------------- APPLICAIN FOR SANITATION PERMIT Permit o. ....,! .------••-•- ----------------- ----------'---------------------------- �1 {lomplete in Duplicate) ---- --- This Permit Ex ires 1 Yew From Date Issued Date Issued . -- r�� r3© -Zs Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Or inance No. 549. lr JOB ADDRESS AND LOCATION - r •------------- Owner's Name - sem------- ------------------------------------------------------------------------------------- Phone--�- -7 Address - k �_ Contractor's Name .................. t'is Phone.. Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: � Number of bedrooms umber of baths __ of size -------7A5?4__/- ___________________________ ' Water Supply: Public system ❑ Community system ❑ Private ❑ Depth TO Water Table A.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej—Hardpan ❑ Previous Application Made: {If yes,date....................) No Ek"'New Construction: Yes 8'�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well_ __ --------Distance from�J�foundation__��__-_._.._..Material___ t.�+�1,.- [ � _ __•___Liquid d �.. epth____-_ _.------_____Capacity._ .�P No. of compartments-----e --�.� Disposal field: Distance from nearest well....._—"^"__-_._Distance from foundation.�Q..r..........Distance to nearest lot line.�_......... Number of lines______/_________________________Length of each line.-- ------.------Width of trench.Z�_`'________..._-_.... � Type of filter material.-TD_C-A�-------=Depth of filter material-__f�_`_----------Total length_____ ...`________________________ Seepag Pit: Distance to nearest well---- '----------Distance foundation_- _"- . ... to nearest lot linq6....I......... Number of pits-----I--------------Lining material___�__1_a_G^_.Size: Diameter__._i-.?--q-.........Depth------AJ_^__r_____-_-___- Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material_______-.___-_______-______________-_ ❑ Size: Diameter----------------------------- -------Depth----------------------------------------------------Liquid Capacity------------------- --..-..gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____..___.-._---__-____-________._____._. ❑ Distance to nearest lot `line ,--.------[-----•-•---,----------------------------------------------------------------------_--.------------------------- Remodeling and/or repairing (describer Y Xl^"�- �"1' f --------------- --•---- ------ t cp iU----•-- ------------------- - -- --- �c - .. --------•------------- ------------------------------------------------- --------•----------•-----••---•---------•- -•-- - -- •-- ---------•---- ------------------- I------•--•-----------------------------------------_----------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------..__----------•---------.----------•-----------•--------• ----------------- ---• -------•--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (5i ned 9 )--------------------------•----•----------.....---------------------- - - - - --------- -----------------------------------------------------...---------•---(Owner and/or Contractor) B (Title)_ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------r - ----------vsJ_J`�l-�Zf L---- DATE------- .e ' ' - -/--- DATE REVIEWED BY `� =✓ ----------- BUILDING PERMIT ISSUED------------------------------- • . DATE--------------------•----------- --- Alterations and/or ecommendations:_______ __ __ _________ '�� t v:z-� _ -_---_-.-,---__----- / t3/ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------- --------------------------- -------------- FINAL INSPECTION BY:... -------- -- ---------- Date------- - ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS F i